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Otol Neurotol. 2010 Jun;31(4):691-6. doi: 10.1097/MAO.0b013e3181c0e98e.

The history of middle cranial fossa approach to the cerebellopontine angle.

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Department of Otolaryngology, Stanford University, Palo Alto, California 94305, USA.



To investigate the historical origins of the current middle fossa (MF) approach to the cerebellopontine angle (CPA).


A review of more than 30 original articles from the 1880 s to the early 1960s that document the evolution of the MF approach. Historically important journal articles and book chapters in various languages were supplemented by interviews with surgeons instrumental in the adaptation of this method to modern microsurgical neurotology.


The inspiration for the current MF approach could be traced back to the late 19th century extradural subtemporal surgeries for the trigeminal neuralgia performed by Krause and Hartley and the contemporary surgeries performed by Ernst von Bergmenn for treatment of otogenic temporal bone infections. The first case of MF approach to CPA for vestibular nerve section was reported by RH Parry in 1904. In the mid-20th century, otologists found numerous applications for this approach, which gained popularity at the hands of William House. Although his initial MF operations aimed to decompress the internal auditory canal for cochlear otosclerosis, House soon realized the versatility of this approach and performed his first MF acoustic neuroma surgery in 1961.


The current MF approach has its roots in operations for trigeminal neuralgia and otologic surgeries for palliation of temporal bone infections performed in the late 19th century. The earliest reported MF approach to the CPA dates back to 1904 and its application to microsurgical exposure of the internal auditory canal to the late 1950s.

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